Constituição psíquica e subjetividade materna na clínica com bebês acometidos por malformação congênita

Abstract

The practice with babies suffering from congenital malformation in the context of a general hospital is the main reason of this conceptual investigation in the field of psychoanalysis. In the encounter with the babies, one is faced initially with the aesthetics, the delicacy, the developing human frailness and its psychic constitution, which becomes an odd, unsettling experience. The mystery of early childhood, the enigma of the developing child is cast before the spectators eyes. In the acute observation of the mother and her baby carried out by the psychoanalyst there is something instigating and incomprehensible, in which affections incite reflections. The dimensions of infantine psychic constitution and its interface with maternal subjectivity were presented in the construction of the writing. The theoretical concepts regarding psychic constitution were approached from Freudian metapsychology in particular, in order to understand the practice with babies in compliance to the ethics of the unconscious such as defined by psychoanalysis. The notion of psychic apparatus, its structure, its functioning and development revealed themselves to be of crucial importance to the clinical work. The decision to use psychoanalytical theory as the fundamental landmark to the accomplishment of this research was established with the scope of extracting that which psychoanalysis unravels with its discovery and that Freud (1923/2011) described as a procedure for the investigation of psychic processes that would otherwise be hardly accessible (p. 274). In the practice routine of the psychoanalyst in a general hospital and in the medical diagnostic and high-complexity treatment clinic one can find newborn babies and his/her guardians faced with the contingency of congenital malformation in their lives. The most frequent cases are the congenital heart diseases and craniofacial anomalies, associated or not to genetic syndromes; being chirurgical treatment sometimes recommended. The incidence of congenital malformation in newborns is not a rare occurring, and it is among the more challenging medical problems in terms of prevention and cure. Nonetheless, it is important to highlight that the medical differential diagnosis of the malformations described in this work will not be the focus of the present study. Our interest resides, instead, in the case to case particularity, which raises some issues to psychoanalysis concerning psychic constitution and maternal subjectivity in the event of congenital malformation. The baby not only as object of research and treatment by medical science, but also as subject in the maternal speech and marked by the psychological experience of his/her parents features in the foreground. The hospital psychoanalyst envisages the baby-mother encounter as a rest which escapes medical care giving, in order to listen and to intervene in what issingular in this primordial and fundamental relationship. It is worthwhile to accentuate that in the aforementioned clinic that which escapes medicine, the unknown, this rest that concerns the psychoanalyst indicates the active connection between body and psyche in the developing human being. Thus the constant need of theoretical knowledge, so as not to neglect childhood analysis and also to be able to accommodate case to case and its particularities.